Abstract:
Deep brain stimulation (DBS) is an established therapeutic tool for the treatment of Parkinson\'s disease (PD). The mechanisms of DBS for PD are likely rooted in modulation of the subthalamo-pallidal network. However, it can be difficult to electrophysiologically interrogate that network in human patients. The recent identification of large amplitude evoked potential (EP) oscillations from DBS in the subthalamic nucleus (STN) or globus pallidus internus (GPi) are providing new scientific opportunities to expand understanding of human basal ganglia network activity. In turn, the goal of this review is to provide a summary of DBS-induced EPs in the basal ganglia and attempt to explain various components of the EP waveforms from their likely network origins. Our analyses suggest that DBS-induced antidromic activation of globus pallidus externus (GPe) is a key driver of these oscillatory EPs, independent of stimulation location (i.e. STN or GPi). This suggests a potentially more important role for GPe in the mechanisms of DBS for PD than typically assumed. And from a practical perspective, DBS EPs are poised to become clinically useful electrophysiological biomarker signals for verification of DBS target engagement.
摘要:
深部脑刺激(DBS)是一种已建立的治疗帕金森病(PD)的治疗工具。DBS对PD的机制可能源于丘脑-苍白网络的调节。然而,在人类患者中进行电生理询问该网络可能很困难。最近从丘脑底核(STN)或苍白球(GPi)中的DBS中发现了大振幅诱发电位(EP)振荡,这为扩大对人类基底神经节网络活动的理解提供了新的科学机会。反过来,本综述的目的是提供DBS诱导的基底神经节EP的总结,并试图从可能的网络起源解释EP波形的各种成分.我们的分析表明,DBS诱导的苍白球(GPe)的反转录激活是这些振荡EP的关键驱动因素,与刺激位置(即STN或GPi)无关。这表明GPe在PD的DBS机制中的潜在作用比通常假设的更重要。从实践的角度来看,DBSEP有望成为临床上有用的电生理生物标志物信号,以验证DBS靶标的参与。